CAN WE PROMISE PREGNANCY TO EVERY WOMAN TODAY?
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