Perspective
Surviving Infertility

It is not uncommon to have trouble becoming pregnant or experience infertility. Infertility is defined as not being able to become pregnant, despite trying for one year, in women under 35, or after six months in women 35 and over.

Pregnancy is the result of a chain of events. A woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. A man's sperm must join with (fertilise) the egg along the way. The fertilised egg must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy.

Previously only women were blamed for not being able to conceive. However now 40 percent cases of infertility and not being able to bear children are due to male factors. Male factors are impotence or any previous infections, physical problem, operation of the male system. However, the main cause of infertility is the abnormal composition, such as low count, abnormalities of the quality, of semen. While female factors can be ovarian or tubal disease, hormonal disturbances previous infections etc. which may affect fertility in them.

There are many different reasons why a couple might have infertility. One is age-related. Women today are often delaying having children until later in life, when they are in their 30’s and 40’s. A couple of things add to this trend. Birth control is easy to obtain and use, more women are in the work force, women are marrying at an older age, the divorce rate remains high, and married couples are delaying pregnancy until they are more financially secure. But the older you are, the harder it is to become pregnant. Women generally have some decrease in fertility starting in their early 30s. While many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35.

Couples also can have fertility problems because of health problems, in either the woman or the man. Common problems with a woman's reproductive organs affect fertility. Certain lifestyle choices also can have a negative effect on a woman's fertility, such as smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder.

Unlike women, some men remain fertile into their 60’s and 70’s. As men age, however, they might begin to have problems with the shape and movement of their sperm, and have a slightly higher risk of sperm gene defects. They also might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. Men also can have other health problems that affect their sexual and reproductive function. These can include sexually transmitted diseases (STDs), diabetes, surgery on the prostate gland, or a severe testicle injury or problem.

Options in Dhaka
"In recent years much advances have been made for the treatment of infertility. However, the first step to treat infertility is to see a health care provider for a fertility evaluation. He or she will test both the woman and the man, to find out where the problem is", says Dr. Nusrat Zaman Associate Professor in Obstetrics and Gynaecology, Institute of Child and Mother Health ICMH.

Different treatments for infertility are recommended depending on what the problem is. About 90 percent of cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. Sometimes a man has an infertility problem that can be corrected by surgery.

Assisted reproductive technology (ART) has made great improvement for male partners with abnormalities enabling a male to reproduce even with low sperm count.

In vitro fertilisation and embryo transfer IVF and ET is the technical term of 'test tube baby'. Here the fertilisation is made by obtaining the egg and the sperm of the couple after special hormone controls and is incubated for 48 hours. After the embryo is six-cell stage it is again transferred into the uterus of the wife where it grows normally as in any other pregnant woman.

In intrauterine insemination IUI, the semen taken from the husband is transferred into the uterus at a definite time of the cycle.

Females suffering from ovulation failure respond very well with ovulation induction techniques with hormones given at regular monthly cycles.

ART techniques have advanced in the modern world but in Bangladesh, few centres have started in the recent years.

"Treatment for infertility have been done for quite a long time by semen specialists of this country but the modern ART centre require good laboratory support and embryologists who require special training and special team work," reflects the doctor.

"Few centres in Dhaka now have techniques like IUI, ICSI and IVF&ET. Dr. Parveen Sultana, a semen specialist in infertility has successfully delivered the first test tube baby in Bangladesh who were triplets. Other private centres and institution like BIRDEM and BSMMU (ex IPGMR) have started to have specialised units that are working to build up their special units in infertility," says Dr. Nusrat.

If you've been having problems getting pregnant, you know how frustrating it can feel. Not being able to get pregnant can be one of the most stressful experiences a couple has. Both counselling and support groups can help you and your partner talk about your feelings, and to help you meet other couples like you in the same situation. You will learn that anger, grief, blame, guilt, and depression are all normal. Couples do survive infertility, and can become closer and stronger in the process.

By Raffat Binte Rashid
Special thanks to Dr. Nusrat Zaman, Associate Professor in Obstetrics and Gynaecology, Institute of Child and Mother Health ICMH.

Random thoughts

Charcoal

The first thing that reminds you when come across this word is the colour" black". It is dark. It is colourless. Its ashes hide almost every colourful object on this earth. Just imagine how a colourful painting look, if you just smudge a piece of charcoal on it. Probably ghastly . The red, blue, yellow and green colours, all will hide their exuberance under the charcoal black sheet.

Some would say the very word reminds them of an unhealthy greyish hue that almost resembles the filth and the stench of a prison. Yes, a prison. A place where the light rays hardly reach in the daylight and where the dark night can frighten off any living soul by its stark silence. The iron bars of the prison which are as black as the charcoal forms a barrier around the prisoner. Every bar of the cage reminds her about the sins that she has committed. Every heavy breath that she takes makes her count the number of days that she has left before closing her eyes forever. She feels like a raven and wonders if there was any way to escape to somewhere unknown by fluttering her broad dark wings.

She looks down and sees her reflection in the sparkling clear water, held in a small steel water bucket in front of her. A shiver runs down her spine and a mystical smile passes across her lips . To quench her thirst she cups her small
hands to have the last drops of water. But the broad black shackles on her wrists hinders her from making even her last wish come true.

She looks up to the dirty charcoal ceiling and asks god for mercy......

By Sarah Zermin Haq