‘Infertility’ the word itself tells the story...it speaks of negativity in volumes. It’s like saying “not-a-mother” or worse “can’t-be-a-mother”. It is a taboo at least in India and will continue to be until we come up with a positive word for this condition. Although this is not the only thing that needs to change but it will surely give a positive makeover; much like the scheduled caste did for dalits and differently-abled for physically challenged.
What is actually infertility?
- It refers to the inability of an individual (male or female) to contribute to conception, or to a female who cannot carry a pregnancy to full term. For practical purposes, if you have not conceived after trying for one year then you need to consult a doctor for complete work up. On the brighter side, WHO gives you 2 years time before calling the name but in practice, people trying for more than 10 years have also conceived.
You are not alone.
- The World Health Organization (WHO) estimates that the prevalence of infertility in India is around 12.6 percent and considering our population it is a huge number.
The root cause of all the problems is that women don’t make decisions when it comes to family planning.
- An Incident (somewhere in 2008): I was an intern in family planning clinic at a tertiary care govt. hospital in the capital city. A young female, well dressed and apparently from a well to do background came to the clinic for an abortion; but surprisingly she was all alone. I could see the courage she had to gather to come to us on her face; teary eyes, trembling feet and shaky voice. Legally, she could get the baby aborted without husband’s consent but even then she would need someone to accompany her following the procedure (which was free). BUT we had a policy to go for M.T.P. only if the mother opts for contraception, temporary (like copper-T) or permanent (Ligation) (Because if you don’t want this baby, either you should wait or put a full stop) and for that husband’s consent is MUST. In this case the husband or the family clearly didn’t know. Then it struck me; this young lady wanted to space the babies but the husband or the in-laws didn’t want her to. Even her own family or friends were not there with her. She basically didn’t have a say in it. And over the years I realized that this is not uncommon.
In India, brides are made for only one purpose (besides the chores of course).
- A baby delivered in the first year of marriage is seen as a positive sign in Indian household and it is fairly common but it cannot be a good thing if the average age of marriage is 22.2 for women.
Pregnancy within 1 year of marriage; A norm and why it is a problem?
- It may be a good thing for some but problem for others because if you have not conceived by the first anniversary, you would have hit the eligibility mark for infertility by definition. Peer pressure works in family planning too because you are already late if everybody else is getting pregnant. This is the stage when a family affair becomes a big issue for the the whole community.
- Excessive physical or emotional stress results in amenorrhea (absent periods) which may add to infertility. Also, the neglected females who are already facing malnutrition and excessive weight loss are at a greater risk of falling prey to infertility and pregnancy related complications. So, it can turn into a vicious cycle going on for a very long time if not forever.
The paradox of age.
- For a woman, infertility can manifest as either the inability to become pregnant or to maintain and carry a pregnancy to a live birth and both extremes of the fertile age group are bad for that but the younger end is often ignored by the society. However, it is not a coincidence that the WHO has included age as low as 15 years in the operational definition of infertility when the legal age of marriage is 18.
- Many women are waiting until their 30s and 40s to have children and this leads to age becoming a growing cause of fertility problems. Aging not only decreases a woman's chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.
Common causes of Infertility in Indian women:
- Infections of the female genital tract are generally considered to be the leading preventable cause of infertility worldwide, especially in developing countries.
- Sexually transmitted infections (STIs) may constitute as high as 85 percent of these infections. A condom is a simple and effective way to keep all/most of them at bay.
- Another common infection which is often difficult to diagnose is the tuberculosis of genital tract. With the kind of exposure and prevalence of TB in our country, it can happen to anyone. Although it is not fatal but most of the damage occurs silently which only delays the treatment. The good thing is that it is easily treatable.
Breaking the Ice: Males can be infertile too.
- It is a pity that we need a social media campaign to convey that males play equal role in fertility and infertility alike. In fact, in 40 to 50 per cent cases, the male is the affected partner.
- It's because of the social set up that women are blamed for a childless marriage, but men are equally in need of treatment.
- Actually, they are the ones who make the baby a girl or a boy which is another big taboo being imposed on females (but obviously they can’t choose).
- And they are the ones who can prevent all the STIs by using condoms.
Who else can be blamed? Urban lifestyle of course.
- The changing lifestyle is certainly to be blamed for both the male and the female infertility. Smoking, alcohol consumption and delayed marriage are among the main culprits.
Problem bigger than infertility itself: 'The Quacks'.
- These are the unqualified imposers who take advantage of the superstitions, myths and the popular beliefs surrounding the ultimate taboo of infertility.
- They not only rob people of their money but also of their valuable time which only delays the treatment. Each quack visit is an opportunity lost.
Infertility is preventable; yes you read that right.
- Only an estimated 3 to 5 per cent of who are infertile, are due to unknown or unpreventable conditions. Rest all are preventable or at least treatable.
Facing infertility: What to do?
- Consult a qualified practitioner as soon as possible. He/she may be a gynecologist, an IVF specialist or anyone approachable.
- When in doubt, visit a Govt hospital. There are special weekly infertility clinics in all/most secondary and tertiary level hospitals.
- Some hospitals even have an IVF center which provides free consultation and services; like the state of the art IVF center at Lok Nayak Hospital, Delhi.
The right approach to infertility:
- Both the partners should be worked up together to reinforce the fact that the female is not the only one that can be affected.
- Counselling sessions should be staged to chalk out a plan, allay anxiety, bust myths and cater to any all the questions which the couple would like to get answered.
The way out: Not always expensive but a long walk anyway.
- The good part is that 80 per cent of the infertility problems can be corrected through simple medications and advanced and expensive treatment methodologies like the IVF or egg donation are required in only 20 per cent of the cases which usually have some underlying complications.
Be patient and don’t lose hope.
- The work up is in itself a long step-wise process to rule out abnormalities one by one.
- Some tests have to be done on specific days of the menstrual cycle, so the complete work up may take up to 2 to 3 cycles/months or more depending upon the problem.
- Some tests are expensive and a few very painful and the results may take time.
- Even after all these efforts, all the investigations may come out to be normal, it happens but they are still necessary to rule out certain conditions.
- A majority of such patients with unknown underlying cause still respond to simple medications.
- Even when the cause has been identified, the conception may still take time. The treatment is scheduled on the basis of menstrual cycles, so 1 treatment option per month, which amounts to only 12 trials in a complete year.
- With the kind of technology available today, infertility is bound to lose if you have the guts to keep fighting. Time is an important factor in this battle, even more important than money.
My best wishes to all the struggling couples. You may visit http://infertilitydost.com/ for more information, inspiring stories, support groups and more or just contact me.