For most couples, becoming parents is a walk in the park. For many others, it’s an uphill climb. Helping them in their arduous journey to parenthood is a range of treatments that fall under assisted reproductive technology, or ART, for conditions as diverse as low ovarian reserve, severe male factor, advanced maternal age, tubal disease and unexplained infertility.
Hundreds of babies were born in the UAE using ART in 2019 alone, say experts. Medical advances and technological innovations have enhanced the success rate of these procedures.
“ICSI, or intracytoplasmic sperm injection, is the most used treatment at our clinic as it has the best prognosis,” says Dr Ahmad Fakih, Consultant Reproductive Endocrinologist and Infertility at Fakih IVF Fertility Center.
ICSI, or intracytoplasmic sperm injection, is the most used treatment at our clinic as it has the best prognosis.
Traditionally used to address male factor infertility, ICSI is a procedure where a single sperm is injected into the egg during in-vitro fertilisation (IVF), unlike in a normal IVF cycle where one of the many sperms naturally fertilises the egg. As it improves the chances of fertilisation ICSI is increasingly used in couples who don’t have male factor infertility. “Success rate varies between individuals and depends on the cause of infertility and the age of the patient,” adds Dr Fakih. “At best the success rate per transfer is around 60-65 per cent.”
Over the years, the use of a variation of ICSI called intracytoplasmic morphologically selected sperm injection (IMSI), where embryologists can magnify sperms up to 6,000 times and choose the appropriate ones for transfer, has also gone up. “By increasing the magnification, embryologists are able to increase the rate of fertilisation by selecting the sperm with the best morphology — one indication of the best sperm quality,” explains Dr Fakih. “With standard methods, important details such as empty spaces in sperm and details of the shape and smoothness of the nucleus of the sperm go undetected. Studies have found that IMSI improves the success of IVF-ICSI.”
Laboratory breakthroughs and improvements in clinical protocols have also led to safer and more effective procedures.
“As far as the laboratory scene is concerned, there have been so many new developments including improvements in the quality of culture mediums,” says Dr Pankaj Shrivastav, Director and Consultant at Conceive - The Gynaecology and Fertility Hospital in Sharjah and Dubai. “Earlier we could only culture embryos for two-to-three days. Nowadays it’s routine to culture embryos up to five days because of the availability of new culture mediums that can sustain the growth of embryos for up to five days.
“Additionally we can now check whether the chromosomes of the embryo are normal or not before we transfer the embryo back into the uterine cavity. This is done through preimplantation genetic testing (PGT) where one-to-five cells are removed from the embryo using a delicate technique called embryo biopsy, which are then sent to the genetic lab. If we put back an embryo with normal chromosomes, it will greatly enhance the chances of conception.”
Additionally we can now check whether the chromosomes of the embryo are normal or not before we transfer the embryo back into the uterine cavity.
Another innovation that has come in handy in choosing the right embryo for successful pregnancy is the EmbryoScope.
“It’s like a CCTV camera on the embryo, installed within the incubator, to watch how it is developing over the five days — we can see how cell division takes place, whether it happened at the right time and if it was symmetrical,” explains Dr Shrivastav. “All this helps us to decide on the best embryo to put back into the uterine cavity.”
Over time stimulation protocols have also become a lot simpler.
“In the past, one of the worries of ART was the risk of ovarian hyperstimulation,” says Dr Shrivastav. “But now, we have fine-tuned the protocol to such an extent that the risk of hyperstimulation is almost zero. This has made it a lot safer for patients.”
As streamlining of ART procedures and techniques continues, infertility centres haven’t been blind to the psychological impact of such treatments on couples. “This is the most difficult aspect of the fertility journey to deal with,” explains Dr Fakih. “It’s a rollercoaster ride that you can’t get off until you bring your baby home or redefine the definition of your family with your partner.
“However, proper preparation and explanation prior to starting treatment helps. Defining expectations early on also makes the process easier. Patients should be counselled adequately regarding expectations and success rates.
“The most important thing is to be a team throughout the treatment process and not to try to blame one another for the problem. Accept and understand what you are going through, choose to receive treatment by a doctor that you both are comfortable with and educate yourselves.
“No matter what the condition, as long as the couple have sperm and eggs there is always hope.”
Male and female fertility issues in the UAE
Poor sperm quality is a problem men across the world face. “Unless the man has sufficient sperms and they are moving well, he will not be able to achieve
a natural pregnancy,” says Dr Pankaj Shrivastav, Director and Consultant at Conceive — The Gynaecology and Fertility Hospital in Sharjah and Dubai. It’s an issue in the UAE as well, adds Dr Shrivastav, and points towards three main factors. “The excessive smoking that goes on in this region is a major problem. It’s considered macho to smoke shisha or cigarettes, but it has severe detrimental effects on the quality of sperm.”
Combined with a lifestyle that leads to obesity and diabetes, men are left in a situation that compromises the production of sperms or decreases their libidos.
The third major factor is the excessive use of steroid injections among young men who frequent gyms, says Dr Shrivastav. “Some of them take steroid injections to bulk up their bodies. Now steroid injections are nothing but the male hormone testosterone. This has a severe impact on sperm quality; it suppresses the production of sperm; and sometimes it can be irreversible.”
Among women Dr Shrivastav cites polycystic ovarian disease as a common cause for infertility. “This is a condition that is closely related to diabetes and affects a significant number of women in the region. Probably an inherited genetic condition, it is made much worse by the lifestyle in the UAE where women stop making eggs even though they have eggs in their ovaries. I wish girls in schools will be educated about how adverse lifestyle conditions can badly impact their reproductive potential.”