The Road to Fertility

We have all been sharply chastened by our smart watches to stand up, get our bodies moving! What if there was an app to similarly step in and admonish us to stand up for ourselves!  For our rights, and other’s wrongs. For the road we want to take and not to be pushed! To simply stand up, and take charge, of our lives, decisions, step forwards! It would make so much of a difference to the dilemmas of the couple I see in my consulting room daily.  A couple dealing with fertility issues and all the baggage that comes with it ..Pushed by social obligation, societal pressures, burdened by what path the joint family feels is right for them to pursue. It’s a complex  mélange  of emotions, experiences, realisations and finally acceptance! Like a potpourri of every known feeling, and something that is on the table, whether you ordered it or not!! One would assume it would be best tackled with sensitivity, information gathering, and personal processing. But things are starkly ...

  This may sound a little off track, but do read on, it will make sense.  There has been a whole lot written about Britney Spears’ struggle with conservatorship. Something I had been ignorant about till the #FreeBritney gained momentum. As much as it shocks my sensibilities, the fact that a provision like this exists in the developed countries is a rude awakening about human rights. So when does a parent cease to be the authority, and pass the baton to the offspring ? Does it happen at the time a child becomes an adult? Is adulting a verb or a noun or both, in the vocabulary of us millennials? Is it an all or none transformation or do the boundaries blur somewhere down the line? Our Indian societal structure traditionally has been parent heavy, right till the child becomes a parent themselves and then some. However the change is afoot in every fibre of the mesh work that our society is, and ignoring that is only going to cause stitches to drop! Parents still have a control and...

Recently after a consultation concluded , the couple requested the nurse to come back  to my cabin for a quick word. They came in to convey that they had never had a  consultation like this with any Specialist /Gynecologist, and that they are thankful to me for summarising their diagnosis, and plan of action with so much of clarity!  I was taken aback! I graciously acknowledge their kind words and that it was my job to do so. However, it got me thinking     What do you expect when you meet your fertility expert? Grey hair, a crowded clinic, a 2 hour wait period, a prescription and an assurance/ echo of what’s your perception of your medical condition? If you do then most certainly you should not! And yes read along - for this is for you.  You would want a specialist who can sift through all your previous medical files, make a summary, come to a diagnosis and a tentative plan of treatment, and most importantly, convey all of that to you. Believe me it m...

Secondary infertility is inability to conceive or carry ahead the pregnancy again after a woman has once conceived earlier. There are broadly two type of couple here, one who already have a baby and fail to achieve a pregnancy second time around, and secondly, couple who conceive but the pregnancy does not carry forward for any medical reason. These couples suffer for a trauma and emotional stress not very well appreciated. Difficulty in conceiving a second child may come as a shock to the couple, particularly if no problems were experienced before. The reaction that some couples face “ be happy you have one” can be very depressing for a couple desperately trying for a child. The average incidence of secondary infertility is 20-30 percent of the general infertility population. The main causes for secondary infertility are similar to those of Primary infertility like tubal block, endometriosis, fibroid uterus, altered sperm parameters with the added burden of age and lifes...

There was a subject called economics that we science students frowned upon religiously in college days. What could possibly be the attractions of a dry number driven complex topic for the pursuers of life and living beings and the forces that drive them, we asked! The answers came by, albeit a bit delayed, in the years of practise. For the health care is also driven by something we learnt as Demand and supply theory! Especially the optional treatment branches.  Fertility is such a branch, which is catering to healthy couple who are not suffering from a disease (infertility is yet listed as a condition and not as a disease) and is availed of as an optional, even boutique therapy. Only couple under the clutches of infertility realise what can be the devastating effects of the condition. Because is not an emergency or life threatening condition, usually couple have enough time and resources to choose the place of treatment. The question is, are our couples seeking fertilit...

Geoffrey Chaucer said "Time and tide wait for no man”. I would like to put an addendum with due respect to Chaucer, "Time, Tide and Biological Clock wait for no woman". Women mature with age, become more mellowed and beautiful and confidant after the twenties, but does her fertility follow this graph too? Sadly, no! Each month a bunch of eggs, start their journey towards ovulation. Only one best egg is selected and the rest are discarded by a natural selection.  By the age of 37 years there is a sharp decline in the egg reserve and the number steeply declines till the age of 40+ when there are but few good eggs left to come to the aid ofthat persistent sperm and make a living of their own!  Thanks to the advents of science, we now have a way forward with egg freezing or Ooocytecryopreservation as we call it.The American Society of Reproductive Medicine has removed the "experimental" label from oocyte cryopreservation in 2012 and it has been included in ...

We pace through the daily life in an unending rush, especially so in the metropolis. Like a coin, life in a big city has its pro's and con's. Do we stop to think about the effect on life and it's quality and more importantly, fertility and it's quality? lets do the exercise for a moment here! Lifestyle modifications go a long way in improving and improvising the way we live our days and also the number of days we live! The concept has to be drilled into us from the childhood because firstly the foundations built in young age decide how our future shapes up and secondly, because we as a species are in love with that which is easy! Our kids grow chubbier, our adults grow obese and our doctors grow busier! The wholesome effect of an unprocessed diet, hours in open air and away from the addictive screens cannot be overstressed. However, those who live in pigeonhole high rise apartments can but dream of those days which we have taken for granted in our childhood. We can...

What am I talking about? Negativism? Not at all! I am just changing the perspective here from the literary meaning. We would all hope and love to loose some weight, wouldn't we? Barring some extremely lucky individuals who actually can eat to their hearts content and still look fit as a fiddle. One may ask, how does this co relate with the fertility issues. It does, because the basic essential for good fertility is a healthy body. For women AND men. Obesity in men has been known to affect sperm count and motility. And if the background leads to the entire spectrum of diabetes, hypertension,  type A personality and a unhealthy stressed corporate lifestyle, well that's all the ingredients there to adversely effect the well being of the sperms. The high cholesterol, high sugar levels, neuropathy associated with diabetes and the stressed lifestyle which allows for little or no physical activity. For women the problems of weight gain can st...

So, you have been at it, been there, done that and to your utter frustration, "that" has not helped..What now! For the medical jargon junkies, it translates to having done the investigations, been through the ovulation induction, planned the act for the anticipated pregnancy, tried the laparoscopy and still its back to square one. the strip on the pregnancy card never tickled you pink! Your doctor has advised insemination..after the first reservations, it does seem simple enough and quicker perhaps? Hold your horses, for it may not be as simple as it seems. The essential criteria to undergo an insemination, more specifically  an intrauterine insemination is that the fallopian tubes should be patent, the sperm count should not be below a cutoff value and yes, the follicles should grow well and rupture.these are some things you have to make sure are in place before proceeding for an IUI. IUI if done without stimulating the ovaries minimally, usual...

Laparoscopy has come in the fertility management as a boon..or so I thought. It was once a simple minimally invasive way to have a look at the woman's reproductive organs, treat the disease if any and get out safely, without causing the mayhem of an open surgery. But as they say, too much of anything is not good. Along came the enthusiastic laparoscopic surgeons who took up a diagnostic laparoscopy as the first line management of any couple seeking help with their fertility issues. And the brunt was born by the poor ovaries! Drilling of ovaries, a term that you may see on the surgery summary of your papers has a lot of explaining to do. Drilling means making small points with some form of heat, cautery, laser etc. This is essentially done for women with PCOS who DO NOT , I repeat DO NOT ovulate with routine drugs in from of tablets and injections. Apart from the fact that drilling is a surgical intervention, it can cause long lasting irreversible effects if done in the wro...

So it's been some time that you as a couple have been at it and there is nothing to show for..What to do now? Keep trying or chuck the whole idea of a family for now and go back to that demanding crazy hour career routine? Well the decision is yours to take but as an intelligent young person, it should be an informed , well thought of decision. It is a fact that all women are born with a fixed number of eggs and we do not grow any new ones at any point in our lives, unlike the sperms. Also once a woman achieves puberty and starts menstruating, she uses up a cohort of these finite eggs each month of an ovulatory cycle. What I mean by a cohort is that each month a number of immature eggs start the journey towards the final aim of ovulation. The hormone system of the body is sufficient to promote the growth of only one single healthy mature egg over, ideally, a period of 12-14 days. This single mature egg then proceeds to be released for the benefit of the incoming sperms, while the r...

Many a times one would be confronted with this question nagging in the back of mind. I say why cant they go hand in hand...? You ask your doctor and the you trust them doubly. When things do not go as planned, the patient would be better prepared and the doctor would not have to face the mistrust which comes in at this conjuncture. Because our culture teaches us to regard the doctor as 'healer', someone at a pedestral, who is the lifesaver and perhaps a 'common being' shouldnt be the one to question that authority, doesnt mean you as a service reciever should not ask. Many a times in clinical practice I meet patients who have undergone more than 5 or so fertility treatment, even ART procedures, but have no clear understanding of why it was undertaken, what exactly was done, how were the outcomes as per the expectations, even to the limit that whether there were any surplus gametes/embryos frozen for them! Sometimes, they have no records of what they had undergone in the...

Its a logical time to revisit Clomiphene..The Indian Government has banned the use of another Ovulation Induction drug, Letrozole! It was sufficient to wake me from the inertia of writing this blog. So, why am I talking this jargon really? Some of you would ask me "what do I care a bit about the tussle between the government and drugs! My gynaecologist gets me to ovulate"..Well time to sit up and question how and what and a lot more. A good 70% patients in India have no clue about their fertility issues, leave alone the treatment prescribed for the same, duration and feasibility of such a treatment and outcomes verses side effects. Ovulation Induction is the medical process of getting your eggs to grow and finally to ovulate to help conception. It is achieved by Clomiphene citrate or other common drug which was until now in use, i.e Letrozole. Clomiphene works wonders and in patient where ovulation is the only hurdle to pregnancy, it helps approximately 70% women ovulate and ...

The various events for a "Woman's Day" prompted me to think...Why a day? Why not celebrate a Lifetime? The celebration of the many aspects of Womanhood! From a Daughter who brings immense joy to the parents, and is always there for in a quiet, sometimes boisterous ways... To a Sister who walked with you through thick and thin.. To a Girlfriend who brought out the best in you... To a Wife , who made sure you stuck to your guts exploring the best in you! And above all to the Mother, who instilled the best in you!!  All the other pages were handed over to us in a way to execute, all except "Motherhood", which then becomes a woman's prerogative, to initiate and perpetuate until the fulfilment comes in the shape of a bundle of joy, which is incidentally shared by the whole family! Its a huge responsibility, which comes easy to some and as a battle to some others.   If having children was part of your life plan, as is for most of the women,accepting that a baby wo...

All of us can answer differently to the above question! I would say "Creepy Crawlies" of the world..but that does not mean that I would not try to face them when the situation demands, avoid as I may! When it comes to Fears, its like an omnipresent chapter in our lives, the face of it may differ from person to person. But one thing we all are scared of.."Failure"!! How we deal with the fear is another aspect. Some may deny it, others would ignore it, few may succumb to it. Best is to deal with it! It is the same in our journey to fertility, we pass the same stages of denial, ignorance and for some , succumbing to it. Then there are those brave souls who deal with it! Hats off to them!! A woman who has a mortal fear of needles, going through a fertility treatment is to me like a brave soldier who has pulled up her socks and gathered her armamentarium of strengths and has declared war on the hurdles in between her and the conception she so desires!Even though she holl...

The big M "Miscarriage" is like an uninvited demon that casts its shadow in the unsuspecting lives of approximately 15% of women in reproductive years. The first reaction to a miscarriage is invariably of shock followed by a shrug of the shoulder and "Well, I shall manage" attitude. Most of the women, and also doctors would not attach much importance to the incidence. "Its known to happen! literature quotes XYZ %" is what we all hear and also, I may say, tell our patients! Its when it happens for the second time that a thought is spared to what could be going wrong! By the time its third occurrence, all the literature has gone out of the back door, especially for the woman undergoing the trauma. Then we sit down and ask serious questions and put a label "Bad Obstetric History" on an already suffering girl! We are not wrong in doing so medically as the definition of BOH does mention 3 or more recurrent abortions. What we have to think here is not ...

"Treat a Person, not a symptom or a body part" a wise physician would say! But even in our daily lives, do we really follow the exclusivity of choices, or do we just succumb to the over hyped retail chains of goods that are off the shelves? What would you do when choosing some thing optional, not an essential? Fertility treatment falls in the exclusive domain of optional rather than an essential, unlike say a Cesarean Section or a Bypass surgery. It cannot be and should not be an option one chooses off the shelf. First thing that drives a fertility treatment is the wish of the patient. What they want and how soon is the prime concern here. Then comes the clinical opinion on whether what they wish for is realistic and medically sound for the given situation. Associated is the evaluation of the expectations and concerns of the couple. Hence fertility treatment ideally should be tailor made for the clinical diagnosis, wishes of the patient and cater to them as a special couple, ...

It is an invariable question that the fertility couple is bound to pose after the final leg of treatment. The hectic activity is over and now is the time to wait for the results and believe me, it can be very stressful. There is definitely the usual about medication and diet and rest, but the most important culprit that has to be tackled is STRESS!! Women should be advised to do whatever keeps their mind off the outcome of pregnancy. this slow de-petalling with "Will it..wont it" causes a lot of problems. Research has shown there are highest level of stress is documented on the day the final test for pregnancy confirmation is made. The Doctor's advice to the couple has to take care of the waiting period as well as the DAY! One way to look at things is to say to one self, I have given my best as has my doctor, ther's only so much i can do, and quoting Scarlett'O Hara's famous words in Gone with the Wind " 'll think about this tomorrow"! It's a...

Doctors will soon encounter this question more and more! Really, in the kind of highly sensitive medical environment that exists in the Fertility clnic, every little bit we do to ease the stress of these couples is less. Then how can we let our fertility seekin couples undergo the multiple heirarchial approch to clinical treatment? The couple would come for initial consult, laboratory workup, ultrasounds, injections, etc. etc. For each appointment they see a new face, who askes the same uncomfortable questions, makes some inelligible notes and hurries upto another couple without properly satisfying either of them! None of them are open with answering queries, solving problems,addressing the doubts. Some of them are unaware of what the previous doctors instructions were. The couple are left confused, intimidated and stressed out with the entire scenario. The picture reminds me of an Assembly line in a factory of say an automobile company. There are metal frameworks on an assembly line c...

That would be any sane self respecting person's first response to an offer of counseling. As mature adults we would like to believe we are totally capable of managing our lives! It's true to an extent. But when the issue is a highly intricate specialised one like an ART treatment, the parameters change. ART counseling is not all about the treatment and clinical jargon, rather it focuses on one to one interaction of the counselor and the couple, their expectations, their understanding and their comfort. Its a known fact that what you understand thoroughly does not scare or stress you. So when a couple steps in to the seemingly confusing and intimidating realm of fertility treatment, they are in for a whole baggage of doubts, conflicts, half baked information received from the Internet and their own interpersonal issues and insecurities. The stage is set for a highly stressed out one and a half month of treatment process until it reaches a peak at the time of final results of the...