CAN WE PROM­ISE PREG­NANCY TO EVERY WOMAN TO­DAY?

Society - - SOCIETY SAYS SO -

THE LAST two decades have been rev­o­lu­tion­ary for treat­ing in­fer­til­ity. For the cou­ple ex­pe­ri­enc­ing dif­fi­culty in get­ting preg­nant, there is plenty of hope to­day. It is not a lost bat­tle as it was in the past. To­day, fer­til­ity treat­ment is purely sci­en­tific and pre­cise, tar­geted to de­ter­min­ing the cause and treat­ing it. Be­sides, al­most every hur­dle can be over­comed with the help of some amaz­ing med­i­cal break­throughs. For ex­am­ple, a woman with­out an uterus can still have her own child by bor­row­ing an­other’s womb to­day.

FOR A NOR­MAL COU­PLE

Dur­ing nor­mal sex­ual ac­tiv­ity, the se­men which con­sists of mil­lions of sperms, is de­posited in the vagina. From there, the ac­tive and motile sperms travel into the fal­lop­ian tube to meet the egg which is re­leased from the ovary once a month. This is where fer­til­i­sa­tion of the egg oc­curs. The fer­tilised egg mul­ti­plies fur­ther, be­comes an em­bryo and trav­els into the uterus where it fi­nally im­plants and forms a fe­tus and then into a beau­ti­ful baby. So to pro­duce a baby it is ab­so­lutely nec­es­sary that there should be an ef­fi­cient egg, a motile sperm and a func­tional uterus.

FOR A WOMAN WITH­OUT FUNC­TIONAL OVARIES

There has been a grad­ual de­lay in the age at con­cep­tion with to­day’s ca­reer ori­ented women. Very of­ten, women de­lay their preg­nan­cies till 35 years and be­yond and plan preg­nancy af­ter their ca­reers are sta­bilised. Women are born with lim­ited eggs in their ovaries, and when the eggs are ex­hausted, women reach menopause. Fer­til­ity is low, al­most nil in the last 10 years be­fore menopause. In­dian women reach menopause at an av­er­age of 48 years which is about five years ear­lier than their west­ern coun­ter­parts. Hence, women of In­dian eth­nic­ity are rec­om­mended to com­plete their re­pro­duc­tive func­tion be­fore the age of 35 years, to avoid hav­ing to re­sort to as­sisted re­pro­duc­tion. And some­times, ra­di­a­tion ther­apy or chemo­ther­apy used for cer­tain can­cers in young women may tem­po­rar­ily or per­ma­nently dam­age the eggs in the ovaries. The other risk fac­tors that harm eggs are ac­tive smok­ing and some­times even pas­sive smok­ing through ex­ces­sive smok­ing by her part­ner. Pre­vi­ous ovar­ian surgery done for var­i­ous rea­sons, where some part of the ovary may be re­moved, can also be a risk fac­tor. How­ever, in the med­i­cally ad­vanced world we live in, there are op­tions which pro­vide hope for these women to­day. Here are the top two. — Freez­ing or Vitri­fi­ca­tion of eggs is the way we freeze a young woman’s eggs if any of the above risk fac­tors is an­tic­i­pated, in or­der for her to keep young and good qual­ity eggs for her­self when she would need them. But if she has not frozen her eggs and she plans a preg­nancy at a time when her eggs have all been ex­hausted, then she would need an egg donor. — Egg do­na­tion in­volves find­ing an ap­pro­pri­ate anony­mous donor, who is screened for in­fec­tions and other dis­eases such as di­a­betes, thy­roid, etc and matches phys­i­cally with the pa­tient con­cerned. The process in­volves re­triev­ing eggs from the donor, fer­til­is­ing the eggs with the pa­tient’s hus­band’s sperm and plac­ing the em­bryos (ba­bies) in the womb of the pa­tient. This is a vari­a­tion of IVF (In Vitro Fer­til­i­sa­tion or test tube baby). Egg do­na­tion gives ex­cel­lent re­sults in women who have poor qual­ity eggs.

FOR A MAN WITH­OUT FUNC­TIONAL SPERMS

For a preg­nancy to oc­cur, the man’s sperm pen­e­trates the woman’s egg and the two merge to­gether to form an em­bryo. Azoosper­mia is a con­di­tion in which the male does not have any mea­sur­able level of sperms in his se­men. There are two ways of help­ing such cou­ples. — TESA (Tes­tic­u­lar Sperm As­pi­ra­tion) in­volves di­rectly ob­tain­ing sperm from the testes where they are pro­duced. These sperms do not usu­ally pos­sess the abil­ity to pen­e­trate the egg. Hence a process called ICSI (In­tra­cy­to­plas­mic Sperm In­jec­tion) is utilised, in which each sperm is lit­er­ally in­jected into a sin­gle egg un­der an op­ti­cal mag­ni­fi­ca­tion of 400 times with the as­sis­tance of a very spe­cial mi­cro­scope called mi­cro­ma­nip­u­la­tor. ICSI is also used for men with a low sperm count or with re­duced abil­ity of the sperm to move (motil­ity). — Donor sperm, like egg do­na­tion, in­volves a screen­ing process for rul­ing out med­i­cal con­di­tions in the donor at ovu­la­tion. This is de­ter­mined by ul­tra­sonog­ra­phy and the sperms are in­jected into the uterus via a pro­ce­dure called In­tra Uter­ine In­sem­i­na­tion (IUI).

FOR A WOMAN WITH­OUT A WOMB

Un­for­tu­nately, there are cer­tain con­di­tions in which a woman is born with­out a uterus or has to have it re­moved due to med­i­cal rea­sons. With the help of IVF, em­bryos are pre­pared with her eggs and her hus­bands’ sperms and then trans­ferred to an­other woman’s womb. This pro­ce­dure is termed as sur­ro­gacy.

Sur­ro­gates (who carry the baby) also re­quire thor­ough screen­ing, to en­sure that no in­fec­tious dis­ease is trans­mit­ted to the baby. To con­firm that the baby be­longs to the bi­o­log­i­cal par­ents, DNA fin­ger­print­ing is car­ried out so as to make sure that the DNA of the baby is the same as the DNA of the par­ents and not sim­i­lar to the DNA of the sur­ro­gate, who car­ries the baby till de­liv­ery. Re­cently, Uter­ine Trans­plan­ta­tion has been suc­cess­fully tried abroad and about ten chil­dren have al­ready been born. But I think it will take an­other five years be­fore it be­comes a com­mon clin­i­cal ser­vice world over.

FOR A WOMAN WHOSE HUS­BAND IS OVER­SEAS

In the cor­po­rate world, where cou­ples are hardly liv­ing to­gether due to their hec­tic travel sched­ules, preg­nancy can take a ma­jor hit. Thank­fully, the hus­band can now col­lect a se­men sam­ple be­fore trav­el­ling and the se­men can be frozen for eter­nity. The pro­cessed se­men can be thawed when re­quired, and the lady can be in­sem­i­nated with that se­men, pro­vid­ing the pos­si­bil­ity of preg­nancy even in the ab­sence of the hus­band. Se­men freez­ing is also an ex­cel­lent op­tion if young men are un­der­go­ing can­cer treat­ments like chemo­ther­apy or ra­di­a­tion. The se­men is frozen prior to these toxic treat­ments as the sperms in the testes get dam­aged by both ra­di­a­tion and chemo­ther­apy, lead­ing to a poor qual­ity of se­men sam­ple later on. In such cases, the male has the op­tion of hav­ing a child when­ever de­sired by sim­ply us­ing the frozen sperm. To­day, there seems to be prac­ti­cally no rea­son for any cou­ple to be child­less. With the help of ap­pro­pri­ate coun­selling and med­i­cal as­sis­tance, the op­por­tu­nity to be­come a par­ent is now avail­able to al­most every sin­gle woman de­sir­ing to have her own child. It is won­der­ful to give a pos­i­tive re­sult to a child­less cou­ple. But it is the re­spon­si­bil­ity of every cen­ter in­volved with As­sisted Re­pro­duc­tive Tech­nol­ogy (ART), to main­tain strict con­fi­den­tial­ity, thor­ough pa­per­work, ex­cel­lent hy­giene and im­pec­ca­ble stan­dards of care and ethics while car­ry­ing out such pro­ce­dures.

Dr Duru Shah Di­rec­tor, Gy­naec­world Cen­ter for As­sisted Re­pro­duc­tion & Women’s health Panel Con­sul­tant – Breach Candy Hos­pi­tal, Jaslok Hos­pi­tal, Global Hos­pi­tal and Hinduja Health­care

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