new hope for parenthood
"God sends children for another purpose than merely to keep up the race- to enlarge our hearts; and to make us unselfish and full of kindly sympathies and affections; to give our soul higher aims, to call out all our faculties to extended enterprise and exertion, and to bring around our firesides bright faces, happy smiles and loving, tender hearts. My soul blesses the great Father, every day, that he has gladdened the earth with little children." -Mary B Howitt
Indeed this verse rings a bell for every fortunate parent. What can match the joy of bringing a child into the world, watching the baby grow to childhood, adolescence, adulthood and then spread his or her wings to go out and fly? In our part of the world the close connection with the child continues even after they learn to stand on their own feet.
Unfortunately, the picture is not so rosy for childless couples in Bangladesh and elsewhere.
Society can be harsh on people, who do not procreate whether due to medical reasons or by choice- late marriages, economic factors and the need for women to contribute to the family kitty. In Bangladesh, infertile couples are often looked down upon as apaya (unlucky).
The women get the worst end of the stick. In the words of gynaecologist Brigadier General Dr Suraiya Rahman (Rtd), ex-advisor specialist and head of the department of Obstetrics and Gynecology of Combined Military Hospital, who currently practices at Gulshan Group clinic, “ Usually the women folk bear the brunt of childlessness more often and are subjected to all types of investigations and treatment, apart from humiliation in general. Men, as socio-economically dominant figures, do not even come forward with the wife for support in many cases.”
Since the woman has to bear the child, people believe that she shoulders the responsibility of infertility. This goes against the grain of many international studies that indicate that in only 30-40 percent of the cases, the woman is responsible for infertility, while men are responsible in another 30-40 percent of the cases. Both are accountable in 10 percent of the cases and in another 10 percent, infertility is unexplained.
Many couples need counseling as they swing between disbelief, anger and guilt. Dr Shaheen Islam, professor of Department of Psychology, Dhaka University and consultant psychologist, points to a thesis by her student Arifa Rahman, titled Family structure and social support: impact on life stress, coping patterns and mental health. According to this document, childless women are more affected than their male counterparts in terms of coping patterns and mental health.
Thankfully, as far as the medical reasons go, there is room for hope. There are several infertility clinics which offer couples a gamut of options. Though the success rate of intracytoplasmic sperm injection (ICSI, a more modern technique of test tube baby) is around 40 percent by and large, there are many elated parents who have surmounted medical hurdles and gone on to have children. Alternatively, some have gone in for adoption. What is remarkable is that the subject of infertility has come out of the closet, with many opting for diverse routes to have children and displaying the courage to talk about this sensitive issue.
Here's a look at the inside story of childlessness and how to overcome it:
The spiritual route
In many Asian countries, offspring are regarded as a gift of God. Devotion and dedication often take childless couples to places of pilgrimage- with some measure of success. One of the famous cases is the birth of Jahangir to Mughal Emperor Akbar. History has it that after exhausting all options of having a child, Akbar went to Sikri village, 40 km from Agra, India. Here he sought the blessing of the saint Sheikh Salim Chisti. The Sufi saint, who was Akbar's advisor and teacher, predicted that the emperor would have three sons. The prediction proved right, and Akbar's son Jahangir was named Salim after the saint.
Even in the hustle, bustle of modern life, the spiritual path attracts many believers. Kaniz Tahmina Sultana, who had a child after 15 years through medical intervention, says: “My precious daughter, Simreen, (a little over a year old) was born through the blessing of God. Before I had a child, life was empty. I could not find peace anywhere. I think that God's blessing is the most important factor in having a child.”
A striking instance of a successful adoption is that of Indian couple Sayantani (a development consultant) and her husband Dharmendra Gaddam (counsellor, political in the Indian High Commission). One only needs to look at the sprightly, bright seven-year-old Tulsi to realise that adoption is a definite and happy option for childless couples.
What immediately comes to mind when you meet the couple is that they are completely open and at ease with the adoption. “Sometimes we have to explain to our daughter's friends and children in the extended family. Adoption has been equated with a step child. Unfortunately our fairy tales don't support step mothers and step daughters,” says Sayantani.
Confessing to “an emptiness” when her little niece would go away, she did have a positive attitude to the age-old option of adoption. Though her Delhi gynaecologist suggested the In Vitro Fertilisation (IVF) and adoption routes and explained the procedures, Sayantani was clear that she and her husband would take the path of adoption. Why not IVF? “I felt too exposed to medicine and laboratories. I was also told that the success rate of IVF at that time, the mid-'90s, was 20-25 percent. This was not encouraging and even my husband was awkward with the whole procedure.”
Meanwhile, Dharmendra said he needed time to think over the issue. Among his concerns was that of educating himself on the score of genetics and socialisation of the child. However once he had made up mind, these were not what he calls, “overwhelming factors.”
There are other people who have turned their backs on adoption. In one case, the wife, a doctor, got married relatively late at the age of 33 and was unable to have a child. While she was open to the idea of adopting a girl, her husband rejected the idea as he was apprehensive about the child “turning out to be an idiot”. In the beginning, says the wife, there was a lot of heartache and disappointment, especially since she is very fond of children, but gradually acceptance set in and now there are no regrets.
According to the experts, infertility, whether male or female, can be defined as the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse.
For the less lucky medical intervention is one answer to childlessness. In Dhaka there are several infertility clinics the major ones are Bangladesh Infertility Management Centre at Dhanmondi, CARE, Dhanmondi, Harvest Infertility Care Ltd, Banani and Fertility and Sterility Society of Bangladesh at BIRDEM.
According to Dr Mustaque Ahmed, managing director of Harvest Infertility Care Ltd, around 20 percent of the patients who visit a gynaecologist suffer from infertility in Dhaka. In his view, the first step for a childless couple is to gain knowledge about pregnancy. If they are not successful after one year of marriage and regular sex, they need to seek medical treatment.
There are several treatment options for infertile couples. The vast majority of female patients are successfully treated with drugs such as clomiphene citrate. Surgery can also be a means to repair damage to the reproductive organs, such as those caused by endometriosis and infectious diseases.
For male infertility, the line of treatment is the administration of drugs, surgery and assisted reproductive technologies, such as ICSI. Drug therapy and surgery have proved successful for some types of male infertility. However, in most cases, the reason for men's infertility remains unexplained and the treatment methods applied are empirical.
Some patients require more complex medical intervention. Assisted reproductive technologies (ART) refer to various methods geared to overcome barriers to natural fertilisation such as anatomical problems such as blocked fallopian tubes. One of these techniques, In Vitro Fertilisation (IVF) has now been practiced for over 15 years.
Other techniques used are semen analysis by Kruger's strict criteria to exclude male causes. Then there are Ovulation Induction and Intra Uterine Insemination (IUI).
Some clinics also offer Cryopreservation, a technique which means preserving in a frozen condition. The best known Cryopreservation is of semen. This is mostly done in case of cancer of the testicles before treatment of the cancer. Further cyropreserved semen is used in donor insemination. It is possible to freeze fertilised eggs after IVF or ICSI. If more embryos are left after an IVF or ICSI procedure they can be frozen and transferred another time.
Md Ashraf Hossain Khan, chief accountant Merchantex Co (BD) Ltd and his wife, Kaniz Tahmina Sutlanta report a success story in infertility treatment. Five years into their marriage, the lack of a child was beginning to cause depression. Aggravating their despair was the social pressure to have a child. Often she was questioned about the problem and people readily doled out advice on medical treatment or even supernatural methods. As Kaniz points out, “I could not face people in this embarrassing situation and would avoid family gatherings and other functions.”
Having tried unsuccessfully to have a child through the normal route, they tried medical intervention in Bangladesh, India and Thailand. Their efforts, at first didn't pay off. Finally after 15 years, the couple was successful via the ICSI route in Harvest Clinic, Dhaka and had a baby girl.
An elated Kaniz says, “I have considerable respect for Harvest. This clinic suited us well in terms of expense, modern technique, time, comfort and so on.” Today the couple have bid goodbye to what Kaniz says was “an aimless and frustrating existence.” Ashraf, adds: “We are enjoying being together as a family. Our life has changed completely now.”
By Kavita Charanji
Art Work: Sabyasachi Mistry