Infertility can take a terrible psychological toll on couples. Disappointment may go on for years and by the time they go the fertility treatment route emotional reserves are often low.
Add to this situation a global pandemic — with all the uncertainty about physical safety and the worry of financial upheaval — and life becomes extremely stressful. Yet for many the fear of losing time in the quest to conceive is even worse.
The World Health Organisation (WHO) has found that infertility afflicts one in every four couples in developing nations — and while there are now some truly incredible and effective medical treatments, the strain of the journey is undiminished.
Both men and women have been found to have depression, anxiety, and feelings of loss of control, self-confidence, self-esteem and isolation when they are unable to conceive.
A 2016 study conducted of a group of 352 women and 274 men going in for treatments related to infertility found that symptoms for depression is as widespread as 56 per cent in women and 32 per cent in men. In the same group, it was found that 76 per cent women and 61 per cent men had symptoms for anxiety.
The road may be rocky, but here in the UAE specialist centres have a good record of helping couples with assisted reproductive treatments.
However, many procedures were put on hold during the height of lockdown. This did cause some unease among patients, explains Dr Pankaj Shrivastav, Director of Conceive Fertility Hospital.
“In April and May [2020] we stopped. We completed whatever cycles we were doing, but we did not start new cycles,” he says. “After that, things opened up — but people were still reluctant to visit the hospital due to being scared about contracting an infection. But this was all got over by August of last year and since then we’ve had a similar number of patients coming in.
“Even when there was a second lockdown after the new year and a partial lockdown where hospitals saw a rising number of cases and the government had advised all elective surgeries to cease at all hospitals for a period of four to six weeks, we were not impacted because IVF and fertility treatment was given permission to continue.”
Dr Shrivastav is frank in his assessment of why most couples have stuck with fertility treatments even in these unpredictable times. “What I have realised is that when people are seeing others falling sick, they re-evaluate what is important in life,” he says.
“Of course, some people had salary cuts and job losses, which made it difficult for them to embark on fertility treatment. So, a lot of people in these situations looked at their lifestyles and wondered whether it is important to spend money on luxury goods or more important to concentrate on a situation like fertility and get moving with completing their families.”
Fertility centres like Conceive do not decide on which treatment a patient should have based on popularity or simply success. They give various options to couples depending on what is suitable for them.
“If it’s a young girl recently married, nothing wrong with either of them, but they’re just not able to get pregnant we would start with something simple like intrauterine insemination (IUI),” explains Dr Shrivastav.
IUI is a type of artificial insemination where sperm that have been washed and concentrated are placed directly in the uterus around the time an ovary releases one or more eggs to be fertilised.
“However, if she is someone who has blocked tubes, for instance, she can only go in for IVF because there is no other way for her eggs to get in contact with her husband’s sperm.”
With in vitro fertilisation (IVF) mature eggs are collected from ovaries and fertilised by sperm in a lab. Then the fertilised egg (embryo) is transferred to the uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.
However, if the husband has a poor semen sample, the couple will need an Intracytoplasmic Sperm Injection (ICSI) treatment. In this process, a tiny needle called a micropipette is used to inject a single sperm into the centre of the egg. Once fertilisation occurs the fertilised egg (embryo) grows in a laboratory for 1-5 days before being transferred to the woman’s uterus.
In situations where all treatments are possible, clinics will give the choice to the patient and take into consideration the age of the female partner, because the older she is the less successful simple treatments are going to be.
“So even if she has only been married for six months, for a woman of 40 or 41, I would say don’t waste time on simple treatments like ovulation induction or IUI because they are now associated with low success rates,” advises Dr Shrivastav.
“She must get in for something that gives her the best chance of conceiving, which would be IVF or ICSI depending on the husband’s semen quality.” As well as the medical aspect, top clinics offer emotional support for couples going through this stressful experience.
“We encourage the couples who come in for fertility treatment to establish a bond with one of our staff members,” says Dr Shrivastav. “Most ladies latch on to a particular nurse or doctor and they feel more comfortable just ringing up that person, even if they have small queries which they might think are silly – but nothing is silly if it is worrying you.”
This individual support is essential. A study conducted in North America on the pandemic’s effect on the mental health of women between ages 20 and 45 who were undergoing fertility treatment found that 86 per cent have observed a negative impact on their mental health and 52 per cent have reported clinically significant symptoms for depression.
There is good news though. After living with the pandemic for well over a year, hospitals are reporting that patients have become aware of what is safe and what is unsafe and the atmosphere for carrying out fertility treatments has somewhat relaxed.
In the UAE, many people are now vaccinated and anyone who is having any surgical procedure will be having a PCR test done routinely.
In short, people are keen to get on with life — especially creating precious new life.
