Since 1978, more than 9 million children have been born following the use of assisted reproductive techniques. Image Credit: Shutterstock

Three minutes passed, then four, then five. The small screen on the pregnancy kit remained white, a stark reminder that this treatment hadn’t worked either.

The need was an ache they’d been trying to quell for about two years; each month taking basal temperature, checking ovulation strips, each delayed period a sign of hope. Hope shattered when a pregnancy kit was broken out.

Joy and Ran, a South Asian couple living in Dubai who requested anonymity over privacy concerns, had been together almost a decade when they decided they wanted a baby to complete the family picture.

So began an emotional trip to parenthood. They knew it would be a rougher road than some of their friends – “I was already 33,” she says. Age plays a huge role in fertility, say doctors. Dr Shiva Harikirshnan Senior Consultant – Obstetrics and Gynaecology, Medcare Women and Children Hospital, explains: “Female age is the most important factor that affects fertility. The peak age of fertility is between 18 and 28 years. By the age of 30, fertility starts declining in females. The decline becomes more rapid after 35 years. Women have a fixed number of eggs (usually around 2-3 million) and it starts declining even before birth and it declines at the rate of 10 per cent every year.”

“I had insulin resistance. And thyroid problems, and was on medication for both issues.”

What is insulin resistance?
Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t use glucose from your blood for energy. To make up for it, your pancreas makes more insulin. Over time, your blood sugar levels go up.
Insulin resistance syndrome includes a group of problems like obesity, high blood pressure, high cholesterol, and type 2 diabetes.
Some signs of insulin resistance include:
A waistline over 40 inches in men and 35 inches in women
Blood pressure readings of 130/80 or higher
A fasting glucose level over 100 mg/dL
A fasting triglyceride level over 150 mg/dL
A HDL cholesterol level under 40 mg/dL in men and 50 mg/dL in women
Skin tags
Patches of dark, velvety skin called acanthosis nigricans
Source: WEBMD

Some doctors were optimistic about helping them while others dismissed her options. “One said, ‘you are too fat, let’s get you gastric surgery first’.”

After digesting the insult and consulting another professional, six months into trying, the couple decided to try intrauterine insemination (IUI).

What is intrauterine insemination?
Intrauterine insemination (IUI) is a procedure for treating infertility. Sperm that have been washed and concentrated are placed directly in your uterus around the time your ovary releases one or more eggs to be fertilised.
Source: Mayo Clinic

“It took Dh8,000 for two IUI treatments,” she recalls – both tries had left the pregnancy kit screen blank. “We did subsequent months, because of course, by then we were in a hurry to do something about it, we were quite frustrated … But of course, there's a lot of waiting in terms of scans and checks. And finally, it didn’t take.”

Joy went back to the doctor who know proposed in vitro fertilisation (IVF). “He said, ‘If you want you can try more. But if it's not working, you'll be wasting money. You might as well do IVF.’ So we said okay. That was a concern because it was Dh25,000 for one round of IVF. So we said, ‘Okay, we will do one round.’ If it doesn't work, we cannot afford another round.”

And so it began.

”These are the small hormone injections to be taken on the stomach and a whole lot of pills. So oestrogen and progesterone pills, depending on where you are on your cycle. Then injections that would basically boost the number of eggs you produce. So you take that every night. And then on the last day there are like six injections.

“I would have a lot of headaches, a lot of nausea, definitely a lot of mood swings. I was crying one minute and be happy the other minute.

“On the last day, after the six injections, I remember breaking down… After that, you have surgery to extract those eggs. It’s an outpatient surgery that they do.”

“You're sent home the same day. You have some bleeding for the next two or three days, but nothing too severe. And then the clinic calls you and tells you how many eggs they were able to extract; in our case, it was eight eggs, but only three of them fertilised,” she adds.

She recalls asking the doctor to implant two of them but he was adamant on taking the safe route. ”He said multiple pregnancies always have complications.” Fortunately, the first one took!

“We were so looking forward to having a baby. And this was our last chance in everything,” she says. The pregnancy came with its own set of challenges – there were incidents of spotting and hospitalisation, there was gestational diabetes to contend with. “During pregnancy, I used to check my blood sugar three times a day, take insulin four times a day,” she says.

As for cravings – when you have such a high risk pregnancy, they scare you, you are too afraid to indulge them, she says. “I was eating so well that by the end of my pregnancy I was down 10kg,” she laughs.

IVF and brain development
A large observational study led by researchers at Karolinska Institutet in Sweden was published in the international journal JAMA Psychiatry in December that states that assisted reproduction techniques (ART) did not mean mental health issues. “We did not find that use of ART had any adverse influence on children's psychiatric health as they go through adolescence. Individuals conceived with ART had a slightly elevated risk of obsessive compulsive disorder compared with the general population but this was explained by differences in the background of the parents, as this excess risk was no longer present after adjustment for various parental characteristics," last author Sara Öberg, associate professor at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, was quoted as saying in a press release.
UAE-based Dr Karunakar Marikinti, Consultant obstetrician and gynaecologist at Prime Hospital, concurs. He says that while this is a common question posed by parents thinking of undergoing IVF treatment and not too many studies have been conducted on the subject, anecdotally there is little evidence to link mental health trouble with the procedure.

Two years on, Joy admits to have put the weight back on post-delivery. But that’s all right, she laughs.

“It was all worth it,” says Joy, smiling at her beautiful baby girl.