Women across most cultures share one thing in common: the idea of marriage and children implanted in their minds at a very young age by society. And the consequent lingering of that thought in their minds through most of their lives.
Then imagine discovering one day that you are not able to bear children. This can be a most difficult and stressful time in a woman's life because it makes her feel incomplete. The condition could apply equally to men.
According to Dr Pankaj Shrivastav, consultant gynaecologist at Conceive, The Gynaecology and Fertility Centre, Sharjah, causes of infertility vary across the globe.
"Worldwide, roughly 15 per cent of couples cannot have any children or are unable to have the desired number, meaning they cannot conceive after having their first child," he says.
Common problems plaguing couples in the West include sexually transmitted diseases, which can damage the fallopian tubes, and postponed pregnancies, where women delay pregnancy tithey touch 35, Shrivastav says.
"In the Middle East and India, infertility issues relating to women are most likely due to conditions such as the polycystic ovary syndrome, which approximately 70 per cent of my female patients suffer from."
Polycystic ovary syndrome (PCOS), a condition in which the ovaries release eggs less frequently, or not at all, is considered one of the leading causes of infertility.
Its symptoms include irregular menstrual cycles, chronic pelvic pain, obesity and excessive growth of facial hair.
Shrivastav says, infertility problems are not limited to women. "Globally, there has been a decline in the quality of semen. There are no definite reasons for this, it could be an environmental issue — for example, due to the many pollutants around," he says.
Programme for help
"The good thing is that, in the UAE, we have athe latest treatments available for men and women," says Shrivastav, who has also introduced a programme, Fitness for Fertility, to help those with PCOS.
"Most women with PCOS are overweight or obese. Through the programme, we advise patients to reach their ideal weight to facilitate pregnancy. Sometimes they do not even require treatment afterwards," Shrivastav says, adding it is crucial for a doctor to explain why a patient needs to lose weight so she is comfortable and confident in doing so to achieve results.
Each year, around 4.5 million couples worldwide experience infertility problems. Approximately 33 per cent of these cases relate to women, another 33 per cent to men and the rest are marked unknown, says Dr Maria Ridao Alonso, head of the Traditional Chinese Medicine Department and Ozone Therapy at the Dubai Herbal and Treatment Centre.
"There is an increasing number of people seeking infertility treatment aover the world, not just in the UAE," Alonso says.
"In many cases, this is due to the fact that more and more couples are opting to have children later and because of unhealthy lifestyles flowing from stress and medication."
Dr Filip De Bruyne, who heads the Gynaecology Department at the Luxemburg University Hospital and is a visiting doctor at Emirates Hospital, Dubai, says people are now learning more about infertility.
"This is logical because awareness in communities around the world about the problem has increased and couples are weinformed by their physicians or the internet for possibilities in treatment," he says.
For those who do not know whom to turn to for help in the UAE, a support group called Making Our Family has been set up by Gillian St Leger, a Dubai-based NLP (neuro linguistic programming) practitioner. The group invites specialists to speak and make presentations on the various aspects of fertility.
"I started this support group because I was infertile for a long time. I was able to conceive through IVF treatment. I understand what people go through and we are here to lend a hand," says St Leger.
Apart from PCOS, the most common causes of infertility in women stem from blocked fallopian tubes and endometriosis (presence of uterine lining in pelvic organs, such as the ovaries). Bruyne says infertility, for the most part, is caused by the "destruction of the fallopian tube", especially after infectious conditions.
Common causes
"Also, ill-advised and, sometimes, aggressive surgery or the presence of endometriosis can prove to be the source of secondary infertility," he says.
There have been some endocrinological reasons (related to glands and hormones of the body and ancillary disorders) that have also been known to reduce female fertility. For men, the problem could be a low sperm count.
"It sometimes happens that women start akinds of tests and [the results] are normal. The man gets tested and there is the problem," Alonso says. "That is so easy to do and could save a lot of investigations and procedures for the woman."
But, there wialways be a group of patients in whom doctors cannot locate the cause of infertility.
Though it is difficult to determine the age group which is most commonly affected, Bruyne says he has noticed that infectious problems seem to affect adolescent women more.
He notes that a growing number of women are postponing pregnancy to a later stage in life. "It is not uncommon to counsel patients between 30 and 35 years of age for their first pregnancy," he says. "This means women are confronted with the problem of infertility later."
One largely accepted medical option in treating infertility IVF (in vitro fertilisation), is generally chosen when aother options have failed. In this case, the egg is fertilised outside the womb.
St Leger, who used this process to conceive her son, now 7 years old, says: "That was a very trying period in my life. I believe people in the UAE would welcome more information regarding the options available to them because it can really wear you down otherwise."
She is planning to organise a line-up of specialists who wispeak on issues, such as preparing the body for conception and building a healthy regime, using alternative methods of conception such as NLP, and ways of dealing with finance and adoption. "I want people to feel there can be a solution while at the same time remaining close to their partner — that's important," says St Leger.
St Leger plans to post athe information provided at the sessions on a website she is in the process of putting together for those who feel more at ease dealing with the situation in private.
Specific plans
Couples or individuals who have opted for specific treatments must ensure they are medically endorsed, according to Bruyne, who also stresses the importance of drawing up a specific plan. This is because different therapies work differently for different couples. "I personally lay more emphasis on surgical treatment than endocrinological support for female infertility," Bruyne says.
He adds that large institutions foster close relationships between infertility surgeons and endocrinologists because although the approaches are different, the aim is to enable successful pregnancy. An alternative to facilitate fertility is by acupuncture, a method promoted by Alonso.
"Studies have shown that acupuncture affects the menstrual cycle by having a neuroendocrine effect on the body," Alonso says. This means acupuncture can play a role in the release of the hormones responsible for regulating a woman's menstrual cycle.
The intervention can also enhance the effectiveness of IVF medications and reduce side effects. It also increases blood flow to the reproductive organs to promote follicle production and ensures egg and endometrial health. Research also shows that acupuncture can strengthen the immune system and decrease inflammations, improve sperm count, balance reproductive hormones and eliminate the interference of stress hormones such as cortisol.
Specialists recommend a check-up for couples or individuals to see if one is infertile. "From the standpoint of the couple, it is crucial to be able to faback on a solid team of dedicated gynaecologists and psychologists to offer the best level of care," Bruyne says. It is important to know that infertility is common and there are ways to prevent and treat it.
"The UAE maintains the same standard in terms of fertility treatments as other countries," Alonso says.
Patients can also benefit by joining a support groups, such as Making Our Family.
Medical treatments: What you can do to conceive
According to Dr Pankaj Shrivastav, consultant gynaecologist at Conceive, The Gynaecology and Fertility Centre in Sharjah, some of the generally accepted treatments for infertility related issues available in the UAE include:
Ovulation Induction (OI): This is the simplest form of fertility treatment and provides medication to stimulate egg production in women who do not ovulate naturally or infrequently.
Intra Uterine Insemination (IUI/AIH): This method is usually performed when no cause for infertility is found or when semen quality is slightly sub-optimal. Also known as Artificial Insemination, it is carried out using the husband's sperm which is prepared in the IVF laboratory and gently placed in the uterus.
Assisted Reproductive Technologies (ART): This is for couples who need advanced treatment in order to conceive and involve sophisticated infertility techniques that are laboratory based.
Invitro Fertilisation (IVF – ‘test tube' baby): This procedure is carried out by first stimulating the ovaries to develop more eggs using Gonadotrophin hormones. The egg and sperm are then mixed and incubated in the laboratory. The eggs fertilise in the lab and the embryos are gently replaced in the uterus.
This treatment is for women with blocked or damaged fallopian tubes or no cause found.
Intra Cytoplasmic Sperm Injection (ICSI): When sperm count is low or there is slow movement, each egg has to be injected with a single sperm. If fertilisation occurs, the embryos are replaced in the uterus. ICSI is the only option in such cases.
Frozen Embryo Replacement (FER): Remaining embryos following IVF or ISCI treatments can be frozen and transferred during a ‘subsequent natural cycle'.
Assisted Embryo Hatching: If repeated failure is experienced with ICSI or IVF treatments, this technique is used. It involves opening the shecovering the embryo and allowing it to hatch. It is then implanted easily.
Blastocyst Transfer: This method helps in the selection of embryos that can easily be implanted after being in the laboratory for five days.
Surgical Sperm Retrieval Techniques: When no sperm is found, this two-procedure technique is used:
Percutaneous Epididymal Sperm Aspiration (PESA) — Here, the sperm is obtained by inserting a fine needle into the Epididymis (the sperm collecting tube outside the testis) and then they are aspirated.
Testicular Sperm Aspiration (TeSa): This is an option to obtain the few sperms available in the testis by inserting a needle into the testis to retrieve tissue. This is then carefully dissected in the lab. The sperm can be frozen or used for ICSI treatment.
