January 10, 2021 7:38:38 pm
By Dr Uma Maheshwari
Kanika and Rajat (name changed), aged 37 years and 40 years, have been married for four years but delayed pregnancy as they were busy with their careers. When they decided to start planning their family, a routine blood test and pelvic ultrasound showed that Kanika’s egg reserve was declining and Rajat’s semen analysis showed very low sperm count and motility. In this situation, in-vitro fertilisation was the only treatment option available for them with several associated complications of reduced pregnancy rates, considering the age, diminished egg reserve and low sperm count and motility. What do we understand from here?
Couples often don’t think about their fertility and its related issues until they want to start planning a family. In fact, not just couples, but young men and women should not wait until illness strikes to make healthy lifestyle choices. At the same time, one also shouldn’t wait until you see a series of negative pregnancy tests. It is important for women and men in their late 20‘s and early 30’s, to get their fertility checkups sooner so that any associated issues can be avoided completely. The recent scenario of delayed marriages, postponing child birth, job stress, pollution, lifestyle changes, smoking, drinking and prolonged working hours trigger the need for proactive fertility check-ups that can help you learn more about your reproductive health, including whether you might have any barriers to future conception. It can even provide insight about how fast your biological clock is ticking.
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Why most men and women say no to tests
Fertility related issues: Most couples do not accept that they have fertility related issues, and believe that if they try for a few years they would eventually conceive.
Peer to peer influence: They are still young and their friends and family had their conception after several years of marriage. This also includes advice from friends and family and their experiences.
Denial: They deny the fact that they are facing difficulty in conception.Advertisement
Hesitation: What if the health care personnel advises some investigation and what if it turns out to be a major issue which may need attention, time and resource planning?
Lack of awareness: What kind of investigation would be advised and whether at all a treatment is available? And whether these kinds of treatments will be affordable or not.
Priorities such as job, family commitments challenges associated with performance, promotions, peer pressure.Advertisement
Fear: It might be the fear of unknown, fear of cost and fear of failure.
Lifestyle modifications: The doctor would advise not to eat junk food, exercise regularly, reduce weight in case of overweight and obesity, stop alcohol and stop smoking if any. Such advice is difficult to follow and needs consistent efforts.
Stress affects fertility and affects treatment outcomes.
What are the kind of parameters monitored during this check-up?
The tests advised for routine fertility check are very simple, cost-effective and non-invasive. These tests do not require hospitalisation nor are associated with pain or complications.
For women, tests include hormonal evaluation (blood tests) which also includes Anti Mullerian Hormone Test (AMH) test, Pelvic scan and tests for ovulation in females, urine examination and random blood sugars. Some women may be advised Hysterosalpingography, involving pushing of dye and taking X-ray to assess whether the fallopian tubes are blocked.
In males: It involves getting a semen analysis done to know sperm count, motility and morphology to understand fertility.Advertisement
What should be the way forward?
Fertility treatment is definitely time bound and couples should not delay the treatment. Infertility is defined as failure to achieve pregnancy after one year of trying without the use of contraception. Above the age of 35 years, one should start seeking treatment after six months. Age is the most important factor determining the success of a woman getting pregnant. Acknowledging and accepting fertility related issues is a huge step towards becoming pregnant. We should not let fear or indecision keep you from planning a child. It is important to approach your doctors on time and get relevant investigations.
(The writer is Consultant – Reproductive Medicine, Cloudnine Group of Hospitals, Bengaluru)
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